title: Functional recovery in lumbar spine surgery: a controlled trial of health behavior change counseling to improve outcomes.
abstract: In 2001, the Institute of Medicine issued a challenge to the American health care system to improve the quality of care by focusing on six major areas: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. The patient-centered model of care directly addresses important limits of surgical care of the lumbar spine, i.e., the lack of effective methods for increasing patient participation and engagement in post-operative follow-up. Recent evidence indicates that post-surgical outcomes are better among those with higher patient activation. We therefore developed an intervention based on the principles of motivational interviewing to increase patient activation: the Functional Recovery in Lumbar Spine Surgery Health Behavior Change Counseling (HBCC) intervention. The HBCC was designed to maximize post-operative engagement and participation in physical therapy and home exercise, to improve functional recovery, and to decrease pain in individuals undergoing elective lumbar spine surgery. From December 2009 through October 2012, 120 participants were recruited and divided into two groups: those receiving (intervention group, 60) and not receiving (control group, 60) the HBCC intervention. The current manuscript provides a detailed description of the theoretical framework and study design of the HBCC and describes the implementation of this health behavior intervention in a university-based spine service. The HBCC provides a model for conducting health behavioral research in a real-world setting.
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD 21287, USA. ehenze1@jhmi.edu
authors.forename: Richard L
authors.initials: RL
authors.lastname: Skolasky
authors.forename: Lee H
authors.initials: LH
authors.lastname: Riley
authors.forename: Anica M
authors.initials: AM
authors.lastname: Maggard
authors.forename: Saaniya
authors.initials: S
authors.lastname: Bedi
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Wegener
mesh_terms: D000368:Aged; D004185:Disability Evaluation; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008161:Lumbosacral Region / Q000601:surgery*; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods / Q000534:rehabilitation*; D010147:Pain Measurement; D010358:Patient Participation / Q000379:methods*; D018802:Patient-Centered Care; D011184:Postoperative Period; D020127:Recovery of Function; D012107:Research Design; D012959:Socioeconomic Factors
keywords: FRiLSS; Functional Recovery in Lumbar Spine Surgery; HBCC; HEP; Health Behavior Change Counseling; Lumbar spine; MI; Motivational interviewing; ODI; Oswestry Disability Index; PAM; PT; Patient activation; Physical therapy; Rehabilitation; SD; Spine surgery; home exercise programs; motivational interviewing; patient activation measures; physical therapy; standard deviation.